During childhood tetanus is not a rare disease in the D.I. Jogjakarta. In the two children’s wards mentioned above during the period July 1, 1954 till July 1, 1958 64 patients suffering from tetanus and aged under 10 were admitted. This group of patients consisted of 39 boys and 25 girls. Mortality among these patients amounted to 40%. Twenty six patients died viz. 18 boys and 8 girls. In the literature about this subject a mortality ranging between 29% and 60% is mentioned. In Djakarta Poesponegoro and Ranti mentioned a mortality of 26% among 484 toddlers and schoolchildren suffering from tetanus, who were admitted to the University children’s ward in the period 1949-1957. the distribution according to age and sex of the patients suffering from tetanus who were admitted to the two children’s wards in Jogjakarta during the period mentioned above is shown in table IX-20.
Table IX - 20.
Survey of 64 patients suffering from tetanus and admitted in the period July 1, 1954 – July 1, 1958 in two children’s wards at Jogjakarta.
In many cases it was impossible to determine the incubation period. In twelve cases this was possible, supposing that the infection with clostridium tetani occurred at the same time as the injury. The incubation period ranged between 4 and 18 days. The three patients with an incubation period of more than 10 days recovered. In 17 cases the portal of entry was known. In 14 cases it concerned injuries of the skin by chopper, lath of bamboo, mail, spoke of bicycle and in two cases tetanus was a complication in patients suffering from burns. We noticed one patient who was very probably infected through the vaccination against smallpox. In the case of six patients who suffered from otitis media and from tetanus the ear could be the portal of entry. In the other 41 cases no portal of entry could be found.
In the hospital the tetanuspatients were treated with phenobarbital 150-300 milligrams per day. A small number also received antitoxin 20,000 to 40,000 units in the first three days after admission. Financial difficulties made it impossible to treat all these tetanus patients with antitoxin. Procain-penicillin was given when an infection of the respiratory tract was presumed. Only once did we observe a patient who also suffered from a relapse of tetanus.
This short case-history is as follows:
A girl, aged 6 was admitted in October 1955 with a serious attack of tetanus. The disease developed after an injury of the skin of her right knee. She recovered in two weeks, and 18 days after admission she was dismissed in good condition. In February 1956, 128 days after discharge she was re-admitted with a serious attack of tetanus. The clinical manifestations were nearly the same as at the time of the first admission. Also this time she recovered and 37 days after the re-admission she could be discharge for the second time. A portal of entry was not found at the second time of admission. Her teeth were sound.